Walter A. Jack BA

NPI 1417212036 - Case Manager/Care Coordinator - 171M00000X

NPI Details
NPI 1417212036
Gender Male
Enumeration Date 07/10/2012
Last Updated 07/10/2012
Entity Type Individual
Active Over 4 years ago
Practice Location
379 6TH AVE W
BRADENTON FL, 34205-8820, US
Phone (941) 782-4100
Fax (941) 782-4101
Business Location
PO BOX 9478
BRADENTON FL, 34206-9478, US
Phone (941) 782-4299
Fax (941) 782-4301
Taxonomy Code 171M00000X
License State
License Number
Remove 1417212036 NPI Number

According to our database, Walter A. Jack BA NPI is 1417212036, taxonomy code is 171M00000X Walter A. Jack BA physically located at 379 6th Ave W, Bradenton FL, 34205-8820. NPI Number Walter A. Jack BA has the Individual type.

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1417212036 NPI number is provided on an as is basis without warranty of any kind. 1417212036 is maintained by the National Plan & Provider Enumeration System. The contents of Walter A. Jack BA are for informational purposes only.